Organization
PERFORMANCE PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN MICHAEL WRAITH DC (PRESIDENT)
(914) 661-8444
Entity
Organization
Contact information
Practice address
150 UNION AVE FL 2, EAST RUTHERFORD, NJ 07073-1917
(201) 414-9545
Mailing address
323 BERGEN BLVD, FAIRVIEW, NJ 07022-1334
(201) 945-9993
(201) 945-8873
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
171100000X
Acupuncturist
—
—
225100000X
Physical Therapist
—
—
225700000X
Massage Therapist
—
—
Other
Enumeration date
03/30/2021
Last updated
03/30/2021
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